The package includes £8 million to recruit up to 750 nurses, midwives and other healthcare workers from overseas, plus 250 support staff for hospitals, primary care and mental health.
Health and social care partnerships will receive £124m to expand care-at-home capacity, with £45m earmarked for the ambulance service.
GPs practices be expected to provide pre-bookable appointments alongside same-day face-to-face and remote appointments.
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The plan was laid out as hours after statistics revealed that a record 4,967 patients had spent over 12 hours in A&E during August waiting to be seen, treated, and subsequently admitted or discharged – an all-time high. The target is four hours.
Worsening delays are believed to have contributed to hundreds of excess deaths over the past six months, with NHS Greater Glasgow and Clyde confirming on Monday that it had launched an investigation into the deaths of two patients who had suffered fatal cardiac arrests in September while waiting to be seen by A&E doctors at its flagship Queen Elizabeth University Hospital in Glasgow.
A&E departments saw record numbers of patients wait over 12 hours in August to be seen and then discharged or admitted
It comes days after the case of a 96-year-old former headmistress with pneumonia, Evelyn Gaw, was raised in parliament after she spent more than 40 hours on a trolley in a draughty corridor at Crosshouse Hospital in Kilmarnock due to a lack of beds.
Her son, Dr Norrie Gaw, a GP and former head of Glasgow’s out-of-hours service, said his mother had been left “frightened, crying, breathless and disorientated”.
He added: “The staff were clearly utterly exhausted but fantastic and very apologetic, but she had to be taken on a trolley to wait in a corridor because of the lack of beds.“It was absolutely lined with patients, and this is not an exception — this is now the norm.’ On Saturday, NHS Grampian issued an appeal to the public via social media on Saturday only to attend if their condition was life-threatening, warning of “extreme pressure” at Aberdeen Royal Infirmary.
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Dr Sandesh Gulhane, a GP and Scottish Conservative health spokesman, said:
“August’s A&E waiting times are the worst on record across every category, seeing tens of thousands of patients suffering excess delays despite the best efforts of overwhelmed frontline staff.
“The fact that these figures cover the height of summer is frankly terrifying – and it’s chilling to imagine the state of our A&Es come winter.”
Jackie Baillie, Scottish Labour health spokeswoman, warned that without urgent action Scotland’s A&E departments “risk a humanitarian crisis” this winter.
Mr Yousaf acknowledged that A&E performance “is not where I or this Government wants it to be”, but insisted that the £600m winter package would help the NHS to cope with “what we expect to be an extremely challenging season”.
He said: “Too many people are waiting far too long for urgent care and treatment. Our A&E departments are working under significant pressure and as with health services across the UK , the pandemic continues to seriously affect these services.
“We’re determined to improve and stabilise performance, working very closely with boards on measures to reduce pressure on our acute sites.
“However, as winter arrives, those pressures will have an undoubtedly detrimental effect on already stretched services, but we will do what we can to mitigate the worst effects.”
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It comes amid growing anger over the situation among NHS staff, with the Royal College of Nursing (RCN) set to open its ballot on strike action on Thursday in protest over their five per cent pay offer, with nurses encouraged to vote in favour.
It will be the first time that its members in Scotland have been balloted to strike.
Doctors are also continuing to weigh up possible industrial action, after eight in 10 BMA members in Scotland said they would consider it.
Dr Lailah Peel, an emergency medicine doctor and the outgoing chair of the BMA’s Scottish junior doctor committee, warned that the NHS was on the brink of a “workforce catastrophe” after a BMA survey of junior doctors in Scotland found that half (49.8%) of those who responded were thinking about quitting their jobs in the next two years.
Junior doctors account for 44% of all the doctors employed by health boards.
Dr Peel said: “We are already desperately short-staffed – we need more doctors across the entire system from primary care through to the highest levels in secondary care – we cannot afford to lose valuable junior doctors who are the future of our senior workforce.
“Urgent action must be taken to make junior doctors feel valued in their workplace and (to) want to stay in Scotland’s NHS for the majority, if not entirety, of their careers.”
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Some 90% of the 320 respondents said issues and challenges of working as a junior doctor in the health service over the past year have lowered their morale, with 52% having told the survey it has significantly lowered their morale.
Dr Peel said: “There are many factors contributing to this feeling of discontentment among the workforce, but this year’s pay award, which is essentially a pay cut in real terms, certainly hasn’t helped matters and has led to many junior doctors re-evaluating their futures within our NHS.”
She added that while pay must be resolved there were “other things the Government can do as quick fixes to make the working lives of junior doctors easier” like uninterrupted breaks at work, a locker to store belongings, and access to hot food while working long shifts out of hours.
“If I can make one final plea to the Scottish Government before I stand down as chair of SJDC, it’s this: act now, please. Do something before it’s too late,” she said.
Mr Yousaf said the government at Holyrood has “already delivered record levels of staffing in NHS Scotland”, with the number of doctors in training, as of June this year, is up 14.3% from September 2006.
He added that 2022 “is set to be the most successful year of medical trainee recruitment in Scotland in the last five years, with a 95% fill rate so far”.
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Despite the strain on services during August, there was evidence of an uptick in elective activity.
The total number of planned operations carried out – 21,218 – was the highest since February 2020, and up 19% compared to July 2022.
This coincided with a push to clear waiting list backlogs.
In July 2022, the Scottish Government set a target to eradicate two year waits for outpatients in most specialities by the end of August 2022, and by the end of September for inpatient and day case procedures.
By the end of August, 76% of outpatient specialities had no or fewer than ten patients on their lists who had been waiting more than two years.
The number of elective surgeries being performed in August was the highest since before the pandemic (Source: Public Health Scotland)
Inpatient data is not yet available, but activity in August – while up – remains 16% below pre-pandemic levels.
There was also a spike in cancellations.
One in 10 procedures scheduled to take place during August called off on the day, or the day before, including 890 which were cancelled for “non-clinical/capacity” reasons such as lack of theatre space, staff or beds – the highest number since 2018.
Dr Gulhane said Mr Yousaf had “offered no solutions to the crisis in our A&E departments”.
He added: “Scotland’s NHS is already at breaking point, and if this is all the Health Secretary can muster, then we are in for a terrifying winter.”
Scottish LibDem leader and health spokesman, Alex Cole-Hamilton, said: “So much of this relates back to staffing. It’s been staring this government in the face for years.
“Last week, a whistleblower told me that the Edinburgh Royal Infirmary operates routinely with 80 fewer nurses than it needs on every single shift.”
Mr Yousaf said: “NHS Scotland’s staffing and funding is already at historically high levels, but as we approach the winter period it is crucial that we look to maximise, and enhance where we can, the capacity of the NHS.
“Given the scale of the escalating cost of living crisis, combined with the continued uncertainty posed by Covid and a possible resurgence of flu, this winter will be one of the most challenging our NHS has ever faced.”